RESUMO
BACKGROUND: Very early discharge from hospital is an element of Ontario midwifery care. Our aim in the present study was to describe the frequency of very early hospital discharge for newborns in Ontario midwifery care over time. METHODS: We conducted a retrospective population-based cohort study, including all midwife-attended singleton term cephalic newborns delivered by spontaneous vaginal birth at Ontario hospitals between April 2003 and February 2017. Our primary outcome was very early hospital discharge (< 6 h after birth) for newborns. Secondary outcomes were pediatric consultation before hospital discharge, phototherapy before hospital discharge and readmission for treatment of jaundice. We used generalized linear mixed models to estimate the relation between maternal, neonatal and hospital factors and very early discharge, while accounting for clustering by hospital. RESULTS: The study cohort included 101 852 newborns born at 89 hospitals. Between 2003/04 and 2016/17, the unadjusted rate of very early discharge decreased from 34.3% to 30.7%. This trend was not significant after adjustment for covariates (odds ratio 1.0, 95% confidence interval 0.99-1.0). Unadjusted rates of pediatric consultation, phototherapy and readmission for jaundice all rose slightly over the study period. Hospital-specific risk-adjusted frequencies of very early discharge ranged from 5% (n = 1479) to 83% (n = 3459) across the 75 Ontario hospitals with at least 100 newborns included in the study cohort. INTERPRETATION: Hospital-level factors contributed to the observed decrease in crude rates of very early discharge for midwifery clients. Wide variation in these rates across Ontario hospitals points to room for improvement to make more efficient use of health care resources by promoting optimal levels of very early discharge.
Assuntos
Tempo de Internação , Alta do Paciente , Cuidado Pós-Natal/estatística & dados numéricos , Cuidado Pós-Natal/tendências , Adolescente , Adulto , Estudos de Coortes , Feminino , Idade Gestacional , História do Século XXI , Humanos , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Ontário/epidemiologia , Paridade , Cuidado Pós-Natal/história , Vigilância em Saúde Pública , Estudos Retrospectivos , Adulto JovemRESUMO
BACKGROUND: Egypt has achieved important reductions in maternal and neonatal mortality and experienced increases in the proportion of births attended by skilled professionals. However, substandard care has been highlighted as one of the avoidable causes behind persisting maternal deaths. This paper describes changes over time in the use of childbirth care in Egypt, focusing on location and sector of provision (public versus private) and the content of immediate postpartum care. METHODS: We used five Demographic and Health Surveys conducted in Egypt between 1995 and 2014 to explore national and regional trends in childbirth care. To assess content of care in 2014, we calculated the caesarean section rate and the percentage of women delivering in a facility who reported receiving four components of immediate postpartum care for themselves and their newborn. RESULTS: Between 1995 and 2014, the percentage of women delivering in health facilities increased from 35 to 87% and women delivering with a skilled birth attendant from 49 to 92%. The percentage of women delivering in a private facility nearly quadrupled from 16 to 63%. In 2010-2014, fewer than 2% of women delivering in public or private facilities received all four immediate postpartum care components measured. CONCLUSIONS: Egypt achieved large increases in the percentage of women delivering in facilities and with skilled birth attendants. However, most women and newborns did not receive essential elements of high quality immediate postpartum care. The large shift to private facilities may highlight failures of public providers to meet women's expectations. Additionally, the content (quality) of childbirth care needs to improve in both sectors. Immediate action is required to understand and address the drivers of poor quality, including insufficient resources, perverse incentives, poor compliance and enforcement of existing standards, and providers' behaviours moving between private and public sectors. Otherwise, Egypt risks undermining the benefits of high coverage because of substandard quality childbirth care.
Assuntos
Entorno do Parto/tendências , Cesárea/tendências , Cuidado Pós-Natal/tendências , Setor Privado/tendências , Setor Público/tendências , Adolescente , Adulto , Peso ao Nascer , Aleitamento Materno/tendências , Estudos Transversais , Egito , Feminino , Humanos , Recém-Nascido , Tempo de Internação/tendências , Pessoa de Meia-Idade , Tocologia/tendências , Parto , Assistência Perinatal/tendências , Gravidez , Qualidade da Assistência à Saúde , Inquéritos e Questionários , Adulto JovemRESUMO
PURPOSE: The purpose of this study was to explore how traditional ritual practices are incorporated into the context of contemporary healthcare. METHODS: An ethnographic study was conducted, using observations and interviews with 27 first-time mothers and 3 nurses at a postpartum nursing center in Taipei, Taiwan. RESULTS: Nursing routines, policies and care provision at the center affected the way traditional ritual practices were conducted. New mothers in this study constructed their everyday activities at the center by incorporating and modifying the ritual practices inside and outside the postpartum nursing center setting. CONCLUSIONS: Social changes have an influence on traditional postpartum ritual practices so a postpartum nursing center becomes a choice for postpartum women. Thus, health care professionals should value their own functions and roles at the postpartum nursing center since the new mothers regard them as the primary support resource to help them recover from giving birth. Therefore, they need to re-examine their practices from the postpartum women's perspective to provide better support and sensitive care to postpartum women and their families.
Assuntos
Enfermagem Obstétrica/tendências , Cuidado Pós-Natal/tendências , Período Pós-Parto/etnologia , Adulto , Instituições de Assistência Ambulatorial/tendências , Atitude do Pessoal de Saúde , Educação não Profissionalizante , Feminino , Humanos , Tempo de Internação , Medicina Tradicional Chinesa/tendências , Mães/educação , Mães/psicologia , Papel do Profissional de Enfermagem , Processo de Enfermagem , Taiwan/etnologiaRESUMO
BACKGROUND: Integration of sexual and reproductive health (SRH), HIV/AIDS and maternal health (MH) services is a critical strategy to confront the HIV/AIDS epidemic, high maternal mortality and the unmet need for contraception. In 2011 the AIDS Information Centre (AIC) in partnership with the Ministry of Health implemented SRH, HIV/AIDS and MH integration services in the districts of Katakwi and Mubende in Uganda. This paper documents challenges encountered in providing these integrated services in the two districts. METHODS: This was a cross-sectional qualitative study conducted in Mubende and Katakwi districts in Uganda. Data were collected using 10 focus group discussions with 89 women attending ANC and postnatal care and 21 key informant interviews with district managers and health workers who were involved in the integrated service delivery. Content thematic approach was used for data analysis. RESULTS: The study findings indicate that various challenges were encountered in integrating HIV, ANC and PNC services. Major challenges included inadequate staff, gaps in knowledge of service providers especially with regard to provision of long-term family planning, limited space, shortage of critical supplies such as HIV test kits, drugs and gloves. CONCLUSION: These findings indicate that the delivery of integrated HIV, SRH and MH services is hampered greatly by health system challenges and depict the need for additional staffing in health facilities, capacity building of health workers and health managers as well as ensuring sufficient supplies to health facilities for smooth implementation of integrated SRH, HIV and MH services.
Assuntos
Fármacos Anti-HIV/uso terapêutico , Prestação Integrada de Cuidados de Saúde , Infecções por HIV/tratamento farmacológico , Cuidado Pós-Natal , Complicações Infecciosas na Gravidez/tratamento farmacológico , Cuidado Pré-Natal , Saúde da População Rural , Adolescente , Adulto , Fármacos Anti-HIV/provisão & distribuição , Fortalecimento Institucional , Estudos Transversais , Prestação Integrada de Cuidados de Saúde/tendências , Feminino , Grupos Focais , Luvas Protetoras/provisão & distribuição , Infecções por HIV/diagnóstico , Infecções por HIV/transmissão , Mão de Obra em Saúde , Humanos , Estudos de Casos Organizacionais , Cuidado Pós-Natal/tendências , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Cuidado Pré-Natal/tendências , Pesquisa Qualitativa , Kit de Reagentes para Diagnóstico/provisão & distribuição , Saúde da População Rural/etnologia , Uganda , Adulto JovemRESUMO
BACKGROUND: The length of postpartum hospital stay is decreasing internationally. Earlier hospital discharge of mothers and newborns decreases postnatal care or transfers it to the outpatient setting. This study aimed to investigate the experiences of new parents and examine their views on care following early hospital discharge. METHODS: Six focus group discussions with new parents (n = 24) were conducted. A stratified sampling scheme of German and Turkish-speaking groups was employed. A 'playful design' method was used to facilitate participants communication wherein they used blocks and figurines to visualize their perspectives on care models The visualized constructions of care models were photographed and discussions were audio-recorded and transcribed verbatim. Text and visual data was thematically analyzed by a multi-professional group and findings were validated by the focus group participants. RESULTS: Following discharge, mothers reported feeling physically strained during recuperating from birth and initiating breastfeeding. The combined requirements of infant and self-care needs resulted in a significant need for practical and medical support. Families reported challenges in accessing postnatal care services and lacking inter-professional coordination. The visualized models of ideal care comprised access to a package of postnatal care including monitoring, treating and caring for the health of the mother and newborn. This included home visits from qualified midwives, access to a 24-h helpline, and domestic support for household tasks. Participants suggested that improving inter-professional networks, implementing supervisors or a centralized coordinating center could help to remedy the current fragmented care. CONCLUSIONS: After hospital discharge, new parents need practical support, monitoring and care. Such support is important for the health and wellbeing of the mother and child. Integrated care services including professional home visits and a 24-hour help line may help meet the needs of new families.
Assuntos
Visita Domiciliar , Pais , Alta do Paciente/tendências , Cuidado Pós-Natal/métodos , Autocuidado/métodos , Apoio Social , Adulto , Aleitamento Materno , Ajustamento Emocional , Feminino , Grupos Focais , Linhas Diretas , Visita Domiciliar/tendências , Humanos , Recém-Nascido , Masculino , Tocologia , Pais/psicologia , Cuidado Pós-Natal/tendências , Gravidez , Pesquisa Qualitativa , Autocuidado/psicologia , Suíça/epidemiologiaRESUMO
PURPOSE: The purpose of this study was to explore how traditional ritual practices are incorporated into the context of contemporary healthcare. METHODS: An ethnographic study was conducted, using observations and interviews with 27 first-time mothers and 3 nurses at a postpartum nursing center in Taipei, Taiwan. RESULTS: Nursing routines, policies and care provision at the center affected the way traditional ritual practices were conducted. New mothers in this study constructed their everyday activities at the center by incorporating and modifying the ritual practices inside and outside the postpartum nursing center setting. CONCLUSIONS: Social changes have an influence on traditional postpartum ritual practices so a postpartum nursing center becomes a choice for postpartum women. Thus, health care professionals should value their own functions and roles at the postpartum nursing center since the new mothers regard them as the primary support resource to help them recover from giving birth. Therefore, they need to re-examine their practices from the postpartum women's perspective to provide better support and sensitive care to postpartum women and their families.
Assuntos
Adulto , Feminino , Humanos , Instituições de Assistência Ambulatorial/tendências , Atitude do Pessoal de Saúde , Educação não Profissionalizante , Tempo de Internação , Medicina Tradicional Chinesa/tendências , Mães/educação , Papel do Profissional de Enfermagem , Processo de Enfermagem , Enfermagem Obstétrica/tendências , Cuidado Pós-Natal/tendências , Período Pós-Parto/etnologia , Taiwan/etnologiaRESUMO
INTRODUCTION: Studies of organizational strategies to incorporate evidence into practice and change provider behavior have shown limited success. The majority of existing research centers on influencing participants to change practice versus understanding what occurs when providers have successfully shifted to an evidence-based practice on their own. This study sought to explore the dynamics involved when individual midwives and physicians transitioned from a practice less based on the evidence to one with more scientific support. Delayed cord clamping was selected as the exemplar practice for the study. METHODS: A qualitative grounded theory approach was used. Seventeen providers were interviewed throughout the United States. This included 5 physicians and 12 midwives from a variety of practice configurations and birth settings including the home, birth center, and hospital. RESULTS: Five themes arose from the stories of the participants: 1) trusting colleagues, 2) believing the evidence, 3) honoring mothers and families, 4) knowing personal certainty, and 5) protecting the integrity of the mother and the baby. The themes served as drivers of change for the providers in what emerged as an evolution toward change rather than a decision to change. From the themes, the model for individual evolution to evidence-based practice was developed. DISCUSSION: Important findings included the significant role that colleagues play in an individual's journey toward a new practice, the fact that the evidence alone was never a sole driver of change, and the emergence of a discourse: Who owns the baby? The model developed as a result of this study provides a new framework for both future research and potential strategies to support the incorporation of evidence into practice.
Assuntos
Prática Clínica Baseada em Evidências , Pessoal de Saúde , Tocologia , Motivação , Obstetrícia , Cuidado Pós-Natal/tendências , Cordão Umbilical , Adulto , Idoso , Atitude do Pessoal de Saúde , Competência Clínica , Constrição , Tomada de Decisões , Parto Obstétrico/tendências , Feminino , Pessoal de Saúde/psicologia , Humanos , Pessoa de Meia-Idade , Enfermeiros Obstétricos , Participação do Paciente , Médicos , Cuidado Pós-Natal/métodos , Gravidez , Lacunas da Prática Profissional , Estados UnidosAssuntos
Bacharelado em Enfermagem/tendências , Tocologia/educação , Tocologia/tendências , Papel do Profissional de Enfermagem , Cuidado Pós-Natal/tendências , Estudantes de Enfermagem/estatística & dados numéricos , Bacharelado em Enfermagem/organização & administração , Feminino , Humanos , Recém-Nascido , Tocologia/organização & administração , Inovação Organizacional , Cuidado Pós-Natal/organização & administração , Gravidez , Medicina Estatal/organização & administração , Reino UnidoAssuntos
Centros de Assistência à Gravidez e ao Parto/tendências , Parto Domiciliar/enfermagem , Tocologia/tendências , Papel do Profissional de Enfermagem , Cuidado Pós-Natal/tendências , Adulto , Feminino , Parto Domiciliar/tendências , Humanos , Admissão e Escalonamento de Pessoal/tendências , Gravidez , Resultado da Gravidez , Reino Unido , Recursos Humanos , Adulto JovemAssuntos
Assistência ao Convalescente/tendências , Tocologia/tendências , Papel do Profissional de Enfermagem , Satisfação Pessoal , Cuidado Pós-Natal/tendências , Adulto , Assistência ao Convalescente/métodos , Aleitamento Materno , Continuidade da Assistência ao Paciente , Feminino , Humanos , Recém-Nascido , Tocologia/métodos , Mães/educação , Relações Enfermeiro-Paciente , Cuidado Pós-Natal/métodos , Reino UnidoRESUMO
CONTEXT: Responding to safety concerns, federal and state legislation mandated coverage of minimum postnatal stays and state legislation in California mandated coverage of follow-up after early discharge. Little is known about the postnatal services newborns are receiving. OBJECTIVE: To describe rates of early discharge and of timely follow-up for early-discharged newborns. DESIGN AND SETTING: Retrospective, population-based cohort study using a 1999 postpartum survey in California. PARTICIPANTS: A total of 2828 infants of mothers with medically low-risk singleton births. MAIN OUTCOME MEASURES: Rates of early discharge (Assuntos
Prestação Integrada de Cuidados de Saúde/normas
, Prestação Integrada de Cuidados de Saúde/tendências
, Diretrizes para o Planejamento em Saúde
, Alta do Paciente/normas
, Alta do Paciente/tendências
, Vigilância da População/métodos
, Adolescente
, Adulto
, California
, Cesárea/estatística & dados numéricos
, Cesárea/tendências
, Estudos de Coortes
, Prestação Integrada de Cuidados de Saúde/estatística & dados numéricos
, Feminino
, Seguimentos
, Pesquisas sobre Atenção à Saúde/estatística & dados numéricos
, Visita Domiciliar/estatística & dados numéricos
, Visita Domiciliar/tendências
, Humanos
, Recém-Nascido
, Tempo de Internação/estatística & dados numéricos
, Tempo de Internação/tendências
, Alta do Paciente/estatística & dados numéricos
, Cuidado Pós-Natal/normas
, Cuidado Pós-Natal/estatística & dados numéricos
, Cuidado Pós-Natal/tendências
, Valor Preditivo dos Testes
, Gravidez
, Estudos Retrospectivos
, Fatores Socioeconômicos
RESUMO
OBJECTIVE: To investigate changing patterns in the provision of maternity care in Victoria based on data collected in three statewide surveys conducted in 1989, 1994 and 2000. METHODS: Postal surveys were mailed to all women who gave birth in Victoria in one week in 1989, and in two weeks in 1993 and 1999, excluding those who had a stillbirth or neonatal death. Questionnaires were sent to women by hospitals and home birth practitioners 5-8 months after the birth. RESULTS: 71.4% of women (n = 790) returned completed surveys in 1989, 62.5% (n = 1,336) in 1994, and 67% (n = 1,616) in 2000. The proportion of women receiving public care increased from 41.1% in 1989 to 63.6% in 1999. Simultaneously, the proportion of women attending public hospital antenatal clinics decreased from 16.6% in 1989 to 8.7% in 1999. Shared care (15.8%) and combined care (29.2%), where women attend a GP or specialist obstetrician for all antenatal care and receive standard public intrapartum care in a public hospital, are now the most common models of public maternity care in Victoria. The proportion of women enrolled in public maternity care who had a known midwife caring for them in labour did not change significantly between 1993 and 1999 (34.9% vs. 30.3%, OR = 0.81 [0.7-1.0]). Sixty per cent of women had a midwife home visit after leaving hospital in 1999 compared with 23.8% in 1993. CONCLUSIONS: The conduct of three population-based surveys at regular intervals over the past 10 years highlights major changes in the organisation of maternity care in Victoria. Comparable information cannot be derived from routine data collections. The Victorian Surveys of Recent Mothers provide an important and unique mechanism for monitoring the impact of shifts in policy and practice over the past decade.
Assuntos
Hospitais Públicos/estatística & dados numéricos , Serviços de Saúde Materna/tendências , Adulto , Feminino , Política de Saúde/tendências , Humanos , Serviços de Saúde Materna/organização & administração , Tocologia/tendências , Modelos Organizacionais , Serviços Postais , Cuidado Pós-Natal/tendências , Gravidez , Cuidado Pré-Natal/tendências , Inquéritos e Questionários , VitóriaRESUMO
Current trends in population dynamics reflect increasing movement from rural to urban environments. As a result the provision of health care for migrants has become a national priority in many countries 'in development'. Information describing the extent to which traditional medical beliefs and practices persist is crucial to the formation of systems of health care for migrant communities. This paper describes the dynamics of medical conservatism. Data analysis obtained from a comparative study of 52 Peruvian women living in a rural highland province and 50 Peruvian women from a migrant squatter settlement, a barriada, indicates that length of exposure to an urban environment is less of a determinant in medical conservatism than age of enculturation. Positive and negative implications of medical conservatism for the delivery of health services are discussed. Recommendations are suggested for greater emphasis on the coordination of programs of health care with community education.